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See a sample rate comparisonCPT 92563 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Tone Decay Tests
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Special Otorhinolaryngologic Services and Procedures |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service AB - Audiology service by audiologist |
| Complexity Level | Low |
| Medicare Fee Schedule | $35.74 national non-facility rate (2026) · View Medicare rates for 92563 |
| Medicaid Fee Schedule | $28.69 median of the 8 states in the free preview · View Medicaid rates for 92563 |
National average reimbursement for CPT 92563 by major payers:
$39.89
$35.32
$36.49
$49.20
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CPT 92563
5 of 25 sample ratesHigher to lower in this preview
Daniel Bateman
Dartmouth-Hitchcock Clinic
$100.72Published rateJamie Evans
$59.86Published rateJacqueline Pardo
University Of Chicago
$54.38Published rateCynthia Stack
Pediatric Faculty Foundation In
$50.38Published rateAusencio Nunez
Progressive Medical Center, S.C.
$26.65Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 92563 vs. Other Special Otorhinolaryngologic Services and Procedures Codes
The CPT 92563 code is part of the Medicine Services and Procedures services used for Special Otorhinolaryngologic Services and Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 92563 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92563. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92563 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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